Nursing Innovation: Step to Full Practice Licensure

Background/local problem With the inception of the Affordable Care Act in 2010 the healthcare system was challenged to be efficient, effective, and patient centered. This transformation has challenged the nursing profession to work to the highest level of the nursing licensure. Nurses hold the distinction of being the largest profession working in healthcare, providing not only much of the direct patient care but also leadership. The Institute of Medicine 2010 The Future of Nursing Report called for nurses to reach for higher education and to become collaborative leaders in implementing change in the healthcare arena. Diabetes is a complex and expensive clinical problem, that requires nursing leadership to create innovations to efficiently and effectively meet patient needs. The purpose of this presentation is to provide an exemplar project that illustrates an advanced practice nurse utilizing research, theory and practice to create a quality improvement project and thus practice to the fullest extent of the nursing licensure to solve a local problem of ineffective diabetic education. Lessons learned and evidence that supports an innovative video diabetic educational program will be discussed to enable others to peruse similar work and/or similar process. Methods After observing and validating a clinical problem, related theories and research were evaluated to create an intervention aimed at improving healthcare quality. Garrand’s Matrix Method was used to guide a search of the literature. A database search resulted in 1219 articles for a preliminary review with 12 articles found to be specific to video education and diabetes. Within these articles themes were identified and a quality improvement project using the plan, do, study, act process was planned. Interventions This presentation will discuss 1) the research process including: formation of clinical questioning, PICO formulation, searching for the best evidence, and translating evidence into practice using theory and 2) evidence guiding a quality improvement project for individuals with Type II diabetes in a primary care setting. The broad focus is on utilization of technology to improve the knowledge of individuals with Type II diabetes. Conclusion/Implications This presentation will help nurses formulate clinical questions and proceed to quality improvement projects. It will highlight the leadership that is available in nursing profession and serve as an example of how nursing knowledge is generating practice improvements and thus provide an example of working at the fullest extent of the nursing license to create solutions to local problem

Lessons Learned: COVID-19 in Post-Corrections Secured Behavioral Rehabilitation

Background: The COVID-19 case rate on June 5, 2020, for prisoners in the United States (US) was 5.5 times higher than the US population case rate (Saloner et al., 2020). Secure facilities were challenged to mitigate the spread of COVID-19. One secure behavioral rehabilitation facility made many changes to facility and program protocols to meet this challenge. Methods: The purpose of this program evaluation was to assess newly implemented infection control measures at a secure behavioral rehabilitation facility and to inform policy and procedure recommendations for the mitigation of COVID-19 transmission in congregate living facilities in the future. Case rates, percent positivity, and case fatality rates were used as surrogate measures to evaluate this facility\u27s COVID-19 program. A PRECEDE/PROCEED logic model was used to guide the program evaluation. Results: Attack rates varied significantly by unit, from 1 resident case (3.94%) to 31 cases (92.26%). The 7-day rolling average ranged from 0.0% to 4.34% positivity during the study period, and 205/355.6 residents (57.56%) were infected during the 3-month study period. Conclusions: COVID-19 places significant logistical and human strain on residents, employees, and administrators of secured congregate settings. Despite extensive infection control measures the study facility experienced a significant number of cases, special hospitalizations, and deaths. Further research is recommended to define adequate infection control measures to vulnerable populations in such settings

Assessing the Impact of an Online Training Module on Knowledge, Practice, and Perceived Attitude Regarding Neonatal Abstinence Syndrome among Pediatric Nurses

Problem Neonatal Abstinence Syndrome (NAS) is increasing in the United States and affects more than 24,000 infants annually. NAS is a disorder that causes infants to experience withdrawal and neurological symptoms. Management of NAS requires nurses to have a high level of knowledge, education, and assessment skills. The day to day care for infants with NAS can be emotionally and physically demanding as infants are very difficult to console, manage and treat. Population prejudice and ethical burden may cause stigmatization to occur. Inconsistencies in evidenced-based practice and absence of standardized clinical practice guidelines increase length of stay, symptoms, costs, and may cause developmental delay in infants. Nurses need focused training regarding the management of NAS. There is little research published assessing the knowledge, practice and attitudes of nursing staff and how they relate to appropriate care of the infant with NAS and the mother with opioid use disorder. Purpose and Objectives The purpose of this study is to evaluate the effect of an online training module on pediatric nurses’ knowledge, practice, and perceived attitude regarding neonatal abstinence syndrome. The objectives of this training module are to improve nurses’: knowledge of addiction and NAS, skills of NAS management, and attitudes regarding maternal addiction and care of infants with NAS. Design The project will be a pre-post survey design with an online training module and self-evaluation that assesses the knowledge, practice, and attitudes of NAS. The project will utilize the PDSA model and the theoretical framework will be based on the Bandura’s Self-Efficacy and Social Learning Theory. Population/Sample/Setting The setting is an inpatient children’s Magnet hospital and teaching facility. The population will be approximately 35 nurses from the Neonatal Intensive Care Unit, NAS nursery, and pediatric unit. Variables studied/Intervention The project will utilize a NAS survey tool that incorporates a Likert Scale, 2 case studies and 2 open-ended questions. This tool will be used as the pretest and posttest. The intervention will be an online training module. Method The methods used to evaluate the data will be a paired t-test or non-parametric equivalent to check for mean differences in pre and post survey responses and descriptive statistics to identify demographic items including units and skill levels. Projection of Findings The projected findings of this project are that nurses who use this online training module will improve their knowledge, skills, and attitudes regarding NAS care and management. Conclusion/Future Implications for Practice The online training module can be applied to future unit orientation and review for yearly competency for nurses to improve the care for infants with NAS and pregnant mother’s with substance use disorder. Infants with NAS require skilled nursing interventions as well as knowledge of withdrawal and addiction. The training will help nurses improve their knowledge, practice, and attitude of NAS. The training will also help nurses understand components of addiction to improve care of infants with NAS and their mothers

Association of Adverse Childhood Experiences with Non-Suicidal Self-Injury and Suicidality: Baseline Survey of the Chinese Adolescent Health Growth Cohort

Many studies have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate the association of 13 common types of ACEs with NSSI, suicidal ideation (SI), and suicide attempts (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 (994 male, 777 female) students aged 11–16 (12.9 ± 0.6) years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included in the analysis. ACEs, including childhood maltreatment, other common forms of ACEs, and smoking, were measured via the Chinese version of the Child Trauma Questionnaire (CTQ) and a series of valid questionnaires that were derived from previous studies. NSSI was measured using the Chinese version of the Functional Assessment of Self-mutilation. SI and SA were measured using questions derived from the Global School Based Student Health Survey. Depressive symptoms were measured via the Chinese version of the Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured via the General Anxiety Disorder-7. Of the included participants, 92.0% reported one or more category of ACEs. Smoking, parent–child separation, emotional abuse, physical abuse, and being bullied were positively associated with NSSI; smoking, parent–child separation, emotional abuse, physical abuse, emotional neglect, and being bullied were positively associated with SI; smoking, emotional abuse, and being bullied were positively associated with SA. The associations of ACEs with NSSI, SI, and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse, and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms. In conclusion, not all the types of ACEs are independently associated with NSSI, and suicidality and other associations may mediate through depressive and anxiety symptoms. Target interventions for adolescents’ NSSI and suicidality should focus on those who have a history of ACEs and depressive and anxiety symptoms

Multigenerational Independent Colony for Extraterrestrial Habitation, Autonomy, and Behavior Health (MICEHAB): An Investigation of a Long Duration, Partial Gravity, Autonomous Rodent Colony

The path from Earth to Mars requires exploration missions to be increasingly Earth-independent as the foundation is laid for a sustained human presence in the following decades. NASA pioneering of Mars will expand the boundaries of human exploration, as a sustainable presence on the surface requires humans to successfully reproduce in a partial gravity environment independent from Earth intervention. Before significant investment is made in capabilities leading to such pioneering efforts, the challenges of multigenerational mammalian reproduction in a partial gravity environment need be investigated. The Multi-generational Independent Colony for Extraterrestrial Habitation, Autonomy, and Behavior health is designed to study these challenges. The proposed concept is a conceptual, long duration, autonomous habitat designed to house rodents in a partial gravity environment with the goal of understanding the effects of partial gravity on mammalian reproduction over multiple generations and how to effectively design such a facility to operate autonomously while keeping the rodents healthy in order to achieve multiple generations. All systems are designed to feed forward directly to full-scale human missions to Mars. This paper presents the baseline design concept formulated after considering challenges in the mission and vehicle architectures such as: vehicle automation, automated crew health management/medical care, unique automated waste disposal and hygiene, handling of deceased crew members, reliable long-duration crew support systems, and radiation protection. This concept was selected from an architectural trade space considering the balance between mission science return and robotic and autonomy capabilities. The baseline design is described in detail including: transportation and facility operation constraints, artificial gravity system design, habitat design, and a full-scale mock-up demonstration of autonomous rodent care facilities. The proposed concept has the potential to integrate into existing mission architectures in order to achieve exploration objectives, and to demonstrate and mature common capabilities that enable a range of destinations and missions

Improving the accessibility and transferability of machine learning algorithms for identification of animals in camera trap images: MLWIC2

Motion-activated wildlife cameras (or “camera traps”) are frequently used to remotely and noninvasively observe animals. The vast number of images collected from camera trap projects has prompted some biologists to employ machine learning algorithms to automatically recognize species in these images, or at least filter-out images that do not contain animals. These approaches are often limited by model transferability, as a model trained to recognize species from one location might not work as well for the same species in different locations. Furthermore, these methods often require advanced computational skills, making them inaccessible to many biologists. We used 3 million camera trap images from 18 studies in 10 states across the United States of America to train two deep neural networks, one that recognizes 58 species, the “species model,” and one that determines if an image is empty or if it contains an animal, the “empty-animal model.” Our species model and empty-animal model had accuracies of 96.8% and 97.3%, respectively. Furthermore, the models performed well on some out-of-sample datasets, as the species model had 91% accuracy on species from Canada (accuracy range 36%–91% across all out-of-sample datasets) and the empty-animal model achieved an accuracy of 91%–94% on out-of-sample datasets from different continents. Our software addresses some of the limitations of using machine learning to classify images from camera traps. By including many species from several locations, our species model is potentially applicable to many camera trap studies in North America. We also found that our empty-animal model can facilitate removal of images without animals globally. We provide the trained models in an R package (MLWIC2: Machine Learning for Wildlife Image Classification in R), which contains Shiny Applications that allow scientists with minimal programming experience to use trained models and train new models in six neural network architectures with varying depths

A high-resolution map of human evolutionary constraint using 29 mammals.

The comparison of related genomes has emerged as a powerful lens for genome interpretation. Here we report the sequencing and comparative analysis of 29 eutherian genomes. We confirm that at least 5.5% of the human genome has undergone purifying selection, and locate constrained elements covering ∼4.2% of the genome. We use evolutionary signatures and comparisons with experimental data sets to suggest candidate functions for ∼60% of constrained bases. These elements reveal a small number of new coding exons, candidate stop codon readthrough events and over 10,000 regions of overlapping synonymous constraint within protein-coding exons. We find 220 candidate RNA structural families, and nearly a million elements overlapping potential promoter, enhancer and insulator regions. We report specific amino acid residues that have undergone positive selection, 280,000 non-coding elements exapted from mobile elements and more than 1,000 primate- and human-accelerated elements. Overlap with disease-associated variants indicates that our findings will be relevant for studies of human biology, health and disease

A z=0 Multi-wavelength Galaxy Synthesis I: A WISE and GALEX Atlas of Local Galaxies

We present an atlas of ultraviolet and infrared images of ~15,750 local (d < 50 Mpc) galaxies, as observed by NASA's WISE and GALEX missions. These maps have matched resolution (FWHM 7.5'' and 15''), matched astrometry, and a common procedure for background removal. We demonstrate that they agree well with resolved intensity measurements and integrated photometry from previous surveys. This atlas represents the first part of a program (the z=0 Multi-wavelength Galaxy Synthesis) to create a large, uniform database of resolved measurements of gas and dust in nearby galaxies. The images and associated catalogs are publicly available at the NASA/IPAC Infrared Science Archive. This atlas allows us estimate local and integrated star formation rates (SFRs) and stellar masses (M$_\star$) across the local galaxy population in a uniform way. In the appendix, we use the population synthesis fits of Salim et al. (2016, 2018) to calibrate integrated M$_\star$ and SFR estimators based on GALEX and WISE. Because they leverage an SDSS-base training set of >100,000 galaxies, these calibrations have high precision and allow us to rigorously compare local galaxies to Sloan Digital Sky Survey results. We provide these SFR and M$_\star$ estimates for all galaxies in our sample and show that our results yield a "main sequence" of star forming galaxies comparable to previous work. We also show the distribution of intensities from resolved galaxies in NUV-to-WISE1 vs. WISE1-to-WISE3 space, which captures much of the key physics accessed by these bands.Comment: 46 pages, 27 figures, published in ApJS (https://ui.adsabs.harvard.edu/abs/2019ApJS..244...24L/abstract ). See that version for full resolution figures and machine readable tables. Go download data for your favorite nearby galaxy here: https://irsa.ipac.caltech.edu/data/WISE/z0MGS/overview.html . The appendix presents detailed analysis of translations to physical quantitie

Copy number variant discrepancy resolution using the ClinGen dosage sensitivity map results in updated clinical interpretations in ClinVar

Conflict resolution in genomic variant interpretation is a critical step toward improving patient care. Evaluating interpretation discrepancies in copy number variants (CNVs) typically involves assessing overlapping genomic content with focus on genes/regions that may be subject to dosage sensitivity (haploinsufficiency (HI) and/or triplosensitivity (TS)). CNVs containing dosage sensitive genes/regions are generally interpreted as â likely pathogenicâ (LP) or â pathogenicâ (P), and CNVs involving the same known dosage sensitive gene(s) should receive the same clinical interpretation. We compared the Clinical Genome Resource (ClinGen) Dosage Map, a publicly available resource documenting known HI and TS genes/regions, against germline, clinical CNV interpretations within the ClinVar database. We identified 251 CNVs overlapping known dosage sensitive genes/regions but not classified as LP or P; these were sent back to their original submitting laboratories for reâ evaluation. Of 246 CNVs reâ evaluated, an updated clinical classification was warranted in 157 cases (63.8%); no change was made to the current classification in 79 cases (32.1%); and 10 cases (4.1%) resulted in other types of updates to ClinVar records. This effort will add curated interpretation data into the public domain and allow laboratories to focus attention on more complex discrepancies.The ClinGen Dosage Sensitivity (DS) Map provides evidenceâ based assessments of the haploinsufficiency and triplosensitivity of genes/genomic regions. We identified 251 clinical copy number variants (CNVs) in ClinVar that overlapped known DS genes/regions but were not interpreted as â likely pathogenicâ or â pathogenic;â these were sent back to their original laboratories for reâ evaluation. Of the 246 that were reâ evaluated, 63.0% resulted in updated classifications, showing that the ClinGen DS Map can be an effective initial step in CNV classification discrepancy resolution.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146425/1/humu23610_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146425/2/humu23610.pd

The Prevalence and Influence of the Combination of Humor and Violence in Super Bowl Commercials

The growing concern over violence in the media has led to vast amounts of research examining the effects of violent media on viewers. An important subset of this research looks at how humor affects this relationship. While research has considered this subset in television programming, almost no research has explored this in the context of advertising. This paper builds on the little research that exists by examining the effects of combining humor and violence, as well as the theoretical approaches that underlie these effects. A content analysis is conducted to identify the prevalence of violence, humor, and the combination of these elements in a longitudinal sample of Super Bowl commercials (2005, 2007, and 2009). Further, we investigate the relationship between the joint occurrence of humor and violence in ads and ad popularity. We conclude that violent acts are rampant in these commercials and that many acts are camouflaged by the simultaneous presence of humor, especially in the most popular ads